Safe Amalgam Removal (SMART Protocol):
Amalgam fillings have been used in dentistry for a long time.
Although they are fillings that can maintain their durability in the mouth for many years, they have started to be used less frequently in recent years due to their damages. The reason for this is the mercury it contains, which makes up most of its content. Amalgam alloy also contains silver, copper and tin. Mercury is a liquid at room temperature. It binds the other metals used in the filling and stabilizes the filling material.
However, in today’s studies, it has been concluded that mercury, even in filling, has harmful effects on human health. Mercury is continuously emitted from amalgam fillings and is absorbed and retained throughout the body, particularly in the brain, kidney, liver, lung and gastrointestinal tract. Mercury output can be intensified by the number of fillings and other activities such as chewing, grinding teeth, and consuming hot liquids. Mercury is also known to be released during the placement, replacement, and removal of dental mercury amalgam fillings.
Nowadays, our patients want to change their amalgam fillings for various reasons (aesthetic, allergic). Due to the high mercury output during amalgam removal, IAOMT; has developed several recommendations to reduce the potential danger of mercury exposure to patients, dentists, dental students, clinical staff, and others. The protocol, which includes the necessary procedures for the safe removal of amalgam by following these recommendations, is called “SMART (Safe Mercury Amalgam Removal Technique)”.
SMART Protocol
- Before amalgam removal, oral vitamin C is loaded to supplement the body with antioxidants. Antioxidants are substances that contribute to the prevention or slowing of cellular damage that may occur due to unstable molecules, which are free radicals, in the heavy metals that are released.
- Mercury gas released should be collected with special devices with the extraoral aerosol feature.
- Machines with strong suction power should be used to isolate saliva secretion during filling removal.
- The patient should be given activated carbon, chlorella, or a similar mouthwash to rinse before and after the procedure. (unless the patient refuses or there are other contraindications that make it clinically inappropriate).
- Especially the patient’s mouth should be protected. For this purpose, Rubber Dam (rubber cover apparatus) should be used. In addition, this apparatus should be placed to cover the mouth with a barrier.
- To ensure that the patient does not inhale any mercury vapor or amalgam particles during the procedure, external air or oxygen supplied through a cannula should also be used for the patient.
- Not only the health of the patient is important, but also that of the doctors and assistants performing the procedure. Physicians and their assistants should wear protective clothing, special protective gloves, visors, goggles, etc.
- In the disassembly process, as large as possible are removed and their disintegration is prevented.
- During the operation, there must be air flow in the environment where the operation will be performed. Ventilation systems with filters are required to prevent the harmful effects of mercury gas. If necessary, the windows of the room should be opened and the dismantling process should be continued.
- Before starting the procedure, the patient’s mouth should be cleaned with a special solution and the mouth should be rinsed after the procedure. In the special solution, there are components such as active-carbon that will keep the metal in its body.
